NPI | 1669730008 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301101902) |
Additional Taxonomies | 208D00000X General Practice (Licence: OH 127592) |
Enumeration Date | 2012-04-23 |
Last Update Date | 2019-10-21 |